醫(yī)學(xué)倫理學(xué)(MedicalEthics)曹永福prof.M.D.醫(yī)學(xué)院醫(yī)學(xué)倫理學(xué)系Departmentofmedicalethics,SDUSchoolofmedicine地址：教學(xué)八樓8203室電話：88382077;電郵：cyongfu@Textbooks：

People’sMedicalPublishingHouseco.LTDTextbooks

HigherEducationPressEnglishtextbooksSomeacademicjournalsThejournalofmedicineandphilosophy倫理學(xué)：王海明Chapter1IntroductionSection1Medicalethics&medicineSection2Morality&medicalmoralitySection3WhytolearnmedicalethicsSection4HowtolearnmedicalethicsSection1Medicalethics&medicineThecharacterofmedicalethicsCategoryandmeaningofethicsMedicalethicshasbeentheintegralpartofthemedicineTheconceptofmedicalethicsThecategoryinthehistoryThemodernmeaningThecategoryofethics規(guī)范倫理學(xué)Normativeethics元倫理學(xué)Meta-ethics美德倫理學(xué)Virtueethics描述倫理學(xué)DescriptiveethicsNormativeethicsToconstructthemoralitysystem(norm,standard)ToachievethepurposeofimprovesocietyandthemankinditselfMoralprinciplesJustice,equality,humanity,freedom,happinessMoralrulesHonesty,cherishlife,self-esteem,modesty,wisdom,restraint,braveness,thedoctrineofthemeanMeta-ethicsAboutthemeaningoftheethicsconceptsandthejustificationofmoraljudgmentCategory:value,good&evil,ought,right；fact&isThejustificationofmeta-ethics:is→oughtVirtueethicsToachievethegoodhumanmoralityTocultivatethevirtueMoralevaluationConscienceandreputationMoralcultivationMoraleducation&self-educationDescriptiveethicsSomehumanitiesandsocialsubjectarerelatedtomoralitySociology,psychology,anthropology,folkloreandsoonMoralsociology,moralpsychology,moralanthropology,moralfolkloreandsoonThemodernmeaningofethicsThesubjectofstudyinghumanmoralityThemethodandprocesstodeterminemorality,theachievementofmoralityMeta-ethics:themethodtodeterminethecodeofethicsDescriptiveandnormativeethics:theprocesstodeterminethecodeofethicsVirtueethics:toachievethecodeofethicsSection1Medicalethics&medicineThecharacterofmedicalethicsCategoryandmeaningofethicsMedicalethicshasbeentheintegralpartofthemedicineTheconceptofmedicalethicsThecategoryinthehistoryThemodernmeaningHumanisticmedicine:thenewextensionofthemedicineBio-medicine&humanisticmedicineMedicalethicsisabranchofhumanisticmedicineInter-disciplinary→thecomponentofmodernmedicineAbranchofChinesemedicalassociationExamcoursetoobtainqualificationofphysicians醫(yī)學(xué)門類1001基礎(chǔ)醫(yī)學(xué)1002臨床醫(yī)學(xué)1003口腔醫(yī)學(xué)1004公共衛(wèi)生與預(yù)防醫(yī)學(xué)1005中醫(yī)學(xué)1006中西醫(yī)結(jié)合1007藥學(xué)1008中藥學(xué)《將人文溶入醫(yī)學(xué)：

發(fā)展醫(yī)學(xué)人文學(xué)科的一種模式》在“醫(yī)學(xué)”門類下設(shè)第九個一級學(xué)科——“人文醫(yī)學(xué)”在“人文醫(yī)學(xué)”一級學(xué)科下設(shè)諸多二級學(xué)科醫(yī)學(xué)哲學(xué)；醫(yī)學(xué)倫理學(xué)；醫(yī)學(xué)心理學(xué)；醫(yī)學(xué)法學(xué)；醫(yī)學(xué)社會學(xué)；醫(yī)患溝通…《中國高等醫(yī)學(xué)教育》（1/2007）MedicalEthicsinSDUEthicsQiluUniversity:medicineistheartofbenevolence（“醫(yī)乃仁術(shù)”）MedicalethicsShandongmedicaluniversity:professionalethicseducationMedicalethicsSDUSchoolofmedicine:professionalfoundationcourse齊魯大學(xué)時期開設(shè)倫理學(xué)課程齊魯大學(xué)時期開設(shè)醫(yī)師倫理學(xué)課程MedicalEthicsinSDUEthicsQiluUniversity:“醫(yī)乃仁術(shù)”MedicalethicsShandongmedicaluniversity:professionalethicseducationMedicalethicsSDUSchoolofmedicine:professionalfoundationcourseSection1Medicalethics&medicineThecharacterofmedicalethicsCategoryandmeaningofethicsMedicalethicsistheintegralpartofthemedicineTheconceptofmedicalethicsThecategoryinthehistoryThemodernmeaningThecategoryinthehistory生命倫理學(xué)Bioethics近現(xiàn)代醫(yī)學(xué)倫理學(xué)Medicalethics醫(yī)德學(xué)Medicalmorals醫(yī)學(xué)倫理學(xué)Bio-medicalethicsMedicalskillaccompanymedicalethicsThehistoryofwesternmedicineandtraditionalChinesemedicineisthehistoryofmedicalethicsTheancientmedicalbooks&practiceofthephysiciansthecommandmentandvirtueofphysiciansPhysician-patientrelationshipSelf-disciplineMedicalmoralsThoughtofancientChinesemedicalethicsThoughtofancientChinesemedicalethics醫(yī)德典故“杏林春暖”“譽(yù)滿杏林”“杏林”醫(yī)界的代名詞ThoughtofancientChinesemedicalethicsQiluUniversity:“博施濟(jì)眾，廣智求真”Thoughtofancientwesternmedicine“Thefatherofmedicine”HippocratesCorpusTextbooks,lectures,research,notesandphilosophicalessaysonvarioussubjectsinmedicineHippocratesoathOnartsThecategoryinthehistory生命倫理學(xué)Bioethics近現(xiàn)代醫(yī)學(xué)倫理學(xué)Medicalethics醫(yī)德學(xué)Medicalmorals醫(yī)學(xué)倫理學(xué)Bio-medicalethics小品文：醫(yī)師是什么？※格特修斯：醫(yī)師的三副面孔：人-天使-魔鬼伏爾泰：醫(yī)生將他所知不多的藥，傾入他所知更少的人。泰勒：醫(yī)生就是開出處方，等病人死亡或者自然痊愈的人。愛迪生：我們可以設(shè)定一個原理：當(dāng)一個國家的醫(yī)生越多，人口就越少?！顜熰嵕幾g：《世界醫(yī)學(xué)史話》，臺灣民生報出版局，1980年。MecicalethicsThemodernhospitalandtheassociationofphysicianswerebornPhysician-patientrelationship&physician-physicianrelationshipSelf-disciplineinprofessionMedicalEthics(ThomasPercival)Thedocumentandworks(books)inmedicalethicsDeclarationofGeneva（WMA）InternationalCodeofMedicalEthics(WMA)Thecategoryinthehistory生命倫理學(xué)Bioethics近現(xiàn)代醫(yī)學(xué)倫理學(xué)Medicalethics醫(yī)德學(xué)Medicalmorals醫(yī)學(xué)倫理學(xué)Bio-medicalethicsKarenAnnQuinlanWhenshewas21,Quinlanbecameunconsciousafterarrivinghomefromaparty.shelapsedintoapersistentvegetativestate.Aftershewaskeptaliveonaventilatorforseveralmonthswithoutimprovement,herparentsrequestedthehospitaltodiscontinueactivecareandallowhertodie.Thehospitalrefused.Althoughshewasremovedfrommechanicalventilationduring1976,shelivedoninPVSforalmostadecadeuntilherdeathfrompneumoniain1985.March29,1954–June11,1985BioethicsManysocial,ethicalandlegalissuesoccurredwiththedevelopmentandclinicalapplicationofbio-medicineRevivaloflife&lifesupporttechnology,euthanasiaandhospicecare,assistedreproductivetechnology,organtransplantation,humantrial,animalexperiment,humangenetechnology,healthcaresystemreformandpolicy…Socialethicsintervention

課程中心“優(yōu)秀課程網(wǎng)站”WhatismedicalethicsThesubjectofstudyingtheidentifyandimplementthegoodmedicalmoralityMedicalvirtueProfessionalvirtue、idealpersonality、cultivationProfessionalmedicalethicsWMA;Medicalprofessionalism;CMDA…Bio-medicalethicsEthicalissuesandtheircountermeasurescausedbybio-medicine…Chapter1IntroductionSection1Medicalethics&medicineSection2Morality&medicalmoralitySection3WhytolearnmedicalethicsSection4HowtolearnmedicalethicsSection2Morality&medicalmoralityThestudyobjectThemoralityandethicinmedicinemoralityðicmedicalmoralityMeaningofmoralityandethicMorality：“行為應(yīng)該如何的規(guī)范”和“規(guī)范在人們身上形成的心理自我”Ethic：“行為事實(shí)如何的規(guī)律”和“行為應(yīng)該如何的規(guī)范”行為應(yīng)該如何的規(guī)范(norm)規(guī)范在人們身上形成的心理自我(personality)行為事實(shí)如何的規(guī)律(humannature)Behaviornorms社會制定或認(rèn)可的關(guān)于人們具有社會效用的行為應(yīng)該如何的非權(quán)力規(guī)范。社會制定或認(rèn)可道德和倫理“具有社會效用”道德和倫理是“應(yīng)該而非必須的非權(quán)力”規(guī)范Virtue一個人的道德人格(Moralpersonality)。一個人在長期的道德行為中所形成和表現(xiàn)出來的穩(wěn)定的心理狀態(tài)?！耙?guī)范”：人們外在的道德?！捌返隆保喝藗儍?nèi)在的道德。Humannature人的“行為”所固有的具有利害人己的屬性的規(guī)律?！靶袨椤保骸皞惱硇袨椤?，具有利害效用的行為?！皞惱硇袨槭聦?shí)如何”：人生而固有的各種倫理行為之本性——道德哲學(xué)家所說的“人性”(humannature)。人性論性善論（孟子）性惡論（荀子）性無善無惡論（告子）性亦善亦惡論（世碩；董仲舒；楊雄）你認(rèn)為人性是善的還是惡的？倫理行為的種類1.無私利他：目的利他的4種行為2.純粹害他：目的害他的4種行為3.純粹害己：目的害己的4種行為4.單純利己：目的利己而手段利己和害己的2種行為5.為己利他：目的利己而手段利他6.損人利己：目的利己而手段損人Thecategoryofmorality(Ⅰ)AccordingtotheapplicationdomainSocialMoralityReligiousMoralityNaturalMoralityIndividualMoralityTheTenCommandmentsIamtheLord,YourCod;donotworshipfalsegods.DonottakethenameofGodinvain.KeepholytheSabbathDay.Honoryourfatherandyourmother.Donotkill.Donotcommitadultery.Donotsteal.Donotbearfalsewitnessagainstyourneighbor.Donotcovetyourneighbor’sspouse.Donotcovetyourneighbor’sbelongings.Thecategoryofmorality(Ⅱ)AccordingtothestructureofsociallifeThemoralityinlove,marriageandfamilyThemoralityinpublicplacesProfessionalismThemeaningofmedicalmoralityNorm&virtueinmedicine在醫(yī)學(xué)領(lǐng)域中形成的人們行為應(yīng)該如何的規(guī)范規(guī)范在人們身上形成的心理自我——品德。ThecategoryofmedicalmoralityMedicalprofessionalmoralityMedicalresearchmoralityHealthcaremanagementmoralityPatientmoralityChapter1IntroductionSection1Medicalethics&medicineSection2Morality&medicalmoralitySection3WhytolearnmedicalethicsSection4HowtolearnmedicalethicsSection3WhytolearnmedicalethicsBenefittotrainmedicalprofessionaltalentBenefittoscientificallydevelopthemedicineBenefittohealthofthehealthcaresystemdevelopmentBenefittotrainmedicalprofessionaltalentMedicalprofessionaltalentshouldbehavebothvirtueandabilityLearningmedicalethicsisagoodstartofmedicalprofessionGeneralsignificance“德之不修，學(xué)之不講，聞義不能徙，不善不能改，是吾憂也。”《論語·述而》“天下萬事，莫不成于才，莫不統(tǒng)于德，無才固不足以成德：無德以統(tǒng)才，則才跋扈之才，實(shí)足以敗，斷無可成?！保▍蔷贤ǎ骸夺t(yī)醫(yī)病書》）Howtousetheprofessionaltalent:

therelationofvirtueandability“德才兼?zhèn)洹薄坝械聼o才”雖然有做貢獻(xiàn)而利人的良好動機(jī)，卻未必會有做貢獻(xiàn)而利人的良好效果，甚至可能好心辦壞事?！坝胁艧o德”既可能做大貢獻(xiàn)而利人，也可能造大災(zāi)難而害人?！坝萌巳缳t”與“用人如器”Specialsignificance醫(yī)務(wù)人員的職業(yè)道德如何，直接影響到防病治病的效果，直接關(guān)系到人人的生死安危，家家的悲歡離合?！耙杂嗾撝t(yī)乃生死所寄，責(zé)任匪輕……當(dāng)以太上好生之德為心?！保鞔t(yī)龔?fù)①t）“人無恒，不可以作巫醫(yī)?！保鬃樱〢goodstartofmedicalprofessionTheconsciousnessofmedicalethics&humanitiesspiritTheethicalthinkingabilityMedicalethicsvalue&medicalprofessionalismGlobalMinimumEssentialRequirementsinMedicalEducation(InstituteforInternationalMedicalEducation,IIME)ProfessionalValues,Attitudes,BehaviorandEthicsrecognitionoftheessentialelementsofthemedicalprofession,includingmoralandethicalprinciplesandlegalresponsibilitiesunderlyingtheprofession;professionalvalueswhichincludeexcellence,altruism,responsibility,compassion,empathy,accountability,honestyandintegrity,andacommitmenttoscientificmethods

anabilitytoapplytheprinciplesofmoralreasoninganddecision-makingtoconflictswithinandbetweenethical,legalandprofessionalissuesincludingthoseraisedbyeconomicconstrains,commercializationofhealthcare,andscientificadvances;self-regulationandarecognitionoftheneedforcontinuousself-improvementwithanawarenessofpersonallimitationsincludinglimitationsofone'smedicalknowledge;

anunderstandingthateachphysicianhasanobligationtopromote,protect,andenhancetheseelementsforthebenefitofpatients,theprofessionandsocietyatlarge;recognitionthatgoodmedicalpracticedependsonmutualunderstandingandrelationshipbetweenthedoctor,thepatientandthefamilywithrespectforpatient'swelfare,culturaldiversity,beliefsandautonomy;

respectforcolleaguesandotherhealthcareprofessionalsandtheabilitytofosterapositivecollaborativerelationshipwiththem;recognitionofthemoralobligationtoprovideend-of-lifecare,includingpalliationofsymptomsrecognitionofethicalandmedicalissuesinpatientdocumentation,plagiarism,confidentialityandownershipofintellectualproperty;abilitytoeffectivelyplanandefficientlymanageone'sowntimeandactivitiestocopewithuncertainty,andtheabilitytoadapttochange;personalresponsibilityforthecareofindividualpatients.

BenefittoscientificallydevelopthemedicineValueorientationandmoralstandardHowtodevelop&oughttohowtodevelopBenefittohealthofthehealthcaresystemdevelopment保證合乎倫理地開展診療行為Twoindispensableelements:medicalmoralityandmedicaltechnology為衛(wèi)生改革和發(fā)展提供價值指導(dǎo)ValueOrientationandrealizationMechanismSecion4HowtolearnmedicalethicsHistoricalmethodcomparativemethodcaseanalysisIdealexperimentPracticemethod歷史方法(Historicalmethod)用歷史眼光去觀察和分析醫(yī)學(xué)道德。揭示醫(yī)學(xué)倫理概況(Almostframe)概括醫(yī)學(xué)倫理內(nèi)容(Contents)3．總結(jié)醫(yī)學(xué)倫理特點(diǎn)(Characteristic)4．指出醫(yī)學(xué)倫理局限性(Limit)比較方法(comparativemethod)對不同醫(yī)學(xué)倫理思想進(jìn)行比較探索“同中之異”或“異中之同”橫比(horizontalcomparison)、縱比(verticalcomparison)、縱橫交比(Crosscomparison)同比、異比、同異交比橫比同一時期的不同醫(yī)學(xué)倫理思想的平行比較案例分析方法(caseanalysis)提取典型的醫(yī)學(xué)倫理案例，發(fā)現(xiàn)、提取、分析其中倫理問題，提出解決醫(yī)學(xué)倫理問題的方案。討論的結(jié)果可能莫衷一是，但這并不影響案例分析法的使用。案例-12007年11月21日，懷孕9個月的李某某因呼吸困難，在其男友肖某某的陪同下赴北京某醫(yī)院檢查，醫(yī)生檢查發(fā)現(xiàn)孕婦及胎兒均生命垂危，建議行剖宮產(chǎn)手術(shù)，但肖某某多次拒絕簽字。在搶救了3小時后，醫(yī)生宣布孕婦搶救無效死亡。案例-22010年12月3日，廣州一名孕婦臨產(chǎn)時出現(xiàn)胎盤